[Use of indicators of fluid responsiveness in septic shock: a survey in public emergency departments]. / Indices de réponse au remplissage vasculaire lors de la prise en charge d'un choc septique : utilisation par les médecins urgentistes.

INTRODUCTION: Fluid therapy is one of the major elements of severe sepsis and septic shock management. A systematic initial fluid bolus is recommended before evaluation of left ventricular filling pressure by the use of indicators of fluid responsiveness, preferentially dynamic ones. A massive fluid therapy could be damaging for the patient. Dynamic indicators of fluid responsiveness are not often relevant in the emergency department. This study was aimed to evaluate the use of indicators of fluid responsiveness by emergency practitioners during septic shock management. STUDY DESIGN: Cross sectional survey using anonymous self-questionnaire. METHODS: We included all practitioners working in public emergency department of Languedoc-Roussillon (France). Primary-end point was the use of one indicator of fluid responsiveness at least. Uni- and multivariate analysis was conducted to find associated factors. RESULTS: Of 232 practitioners included, we collected 149 questionnaires (response rate=64%). Hundred and eight practitioners (72% [64-79%]) used at least one indicator of fluid responsiveness. Fifty-six practitioners (38% [30-46%]) used echocardiography, 54 practitioners (36% [29-44%]) used blood lactate concentration, 45 practitioners (30% [23-38%]) used passive leg raising. The use of indicators of fluid responsiveness is associated with easy access to echography device (odd ratio=2.94 [1.16-7.62], P=0.03). CONCLUSION: Emergency practitioners use preferentially less invasive and less time-consuming indicators of fluid responsiveness.

Doping properties of PEDOT films electrosynthesized under high frequency ultrasound irradiation.

The present study presents the use of high frequency ultrasound (500 kHz, 25 W) for 3,4-ethylenedioxythiophene (EDOT) electropolymerization in aqueous medium in order to investigate its effects on conducting polymer properties. It was shown that mass transfer increases under ultrasound irradiation which improved electropolymerization and the comparison with experiments carried out at the same mass transfer level (4.6 × 10(-5) ms(-1)) puts in evidence that stirring effect is not the only phenomenon induced by ultrasound during electrodeposition. PEDOT films elaborated under ultrasonication present increased doping levels revealed by X-ray Photoelectron Spectroscopy (XPS) analysis, especially in the case of thick films (measured by mechanical probe), thanks to better incorporation of counter ions within polymer matrix as another consequence of mass transport improvement under ultrasound and probably film heating by wave absorption for the highest thicknesses. A dilation of the film under sonication leading to an increase in film thickness was also highlighted. Finally, a refining of the surface structure was also observed via SEM imaging.